In Australia, access to Opioid Replacement Therapy (ORT) poses a problem for clinicians when confronted with multiple requests for ORT treatment. This article forms part of a broader grounded theory study exploring how clinicians apply clinical judgement in managing access to ORT programs. The focus of this article is to report on the codes generated from the study's data analysis and to discuss how they influence clinician responses to the process. From March to August 2012, 35 clinicians from 10 publicly funded ORT clinics within the states of Queensland and New South Wales were recruited. To stimulate clinicians to use their clinical judgment, a scenario was presented requiring participants to choose between two consumers for preferential access to ORT and explain why. Responses as to who should receive treatment first varied between clinicians. Reasoning for their decisions was diverse, except “prioritising” was a consistently presenting element. Previous education, training, work experience, and their peers were all factors identified as influencing their decision making. Not all clinicians were confident with their choice. This study examined how clinical judgement is applied in managing access to ORT, showing variation in clinician responses and the factors influencing those decisions.